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Visual Outcomes After SMILE, LASEK, and LASEK Combined With Corneal Collagen Cross-Linking for High Myopic Correction

Hyun, Sangyoon MD; Lee, Seongjun MD; Kim, Jae-hyung MD

doi: 10.1097/ICO.0000000000001089
Clinical Science

Purpose: To compare the visual and refractive outcomes of small-incision lenticule extraction (SMILE), laser-assisted subepithelial keratomileusis (LASEK), and LASEK combined with corneal collagen cross-linking (LASEK-CXL) surgery for high-degree myopia.

Methods: Medical records of patients with spherical equivalent (SE) greater than −6.00 diopters (D) treated with SMILE, LASEK, and LASEK-CXL were reviewed. Uncorrected distance visual acuity (UCVA), SE, and corneal haze were followed up in the 3 groups for 6 months.

Results: The SMILE group included 69 eyes, the LASEK group included 61 eyes, and the LASEK-CXL group included 40 eyes. At 6 months postoperatively, there were no statistically significant differences in UCVA between the SMILE, LASEK, and LASEK-CXL groups (logMAR 0.00 ± 0.00, 0.01 ± 0.08, and 0.01 ± 0.08, respectively, P = 0.69). The averages of the absolute value of SE were 0.34 ± 0.25 D, 0.50 ± 0.36 D, and 0.42 ± 0.34 D in the SMILE, LASEK, and LASEK-CXL groups, respectively (P = 0.04). The percentages of the patients with a postoperative residual refractive error within ±0.50 D were 84% in the SMILE group, 65% in the LASEK group, and 76% in the LASEK-CXL group. The percentages of the patients with greater than 20/25 postoperative UCVA were 100%, 91%, and 95%, respectively. SMILE produced no postoperative corneal haze. However, 18% of patients treated with LASEK and 25% of those treated with LASEK-CXL had corneal haze at 6 months postoperatively.

Conclusions: SMILE, LASEK, and LASEK-CXL surgery appear to be safe and effective for high-degree myopic correction. However, the SMILE group had no haze and fewer induction of some higher-order aberrations compared with the LASEK and LASEK-CXL groups.

*Department of Ophthalmology, Chungbuk National University, Cheongju, Chunbguk, Korea; and

Nuri Eye Ophthalmic Clinic, Daejeon, Korea.

Reprints: Jae-hyung Kim, MD, Department of Ophthalmology, Chungbuk National University College of Medicine, 1 Sunhwan-Ro, Gaesin-dong, Heungduk-ku, Cheongju, Chungbuk 361-711, Korea (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received August 18, 2016

Received in revised form September 29, 2016

Accepted October 04, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.